在宅療養者の自己決定を支える訪問看護婦の認識と方略

Recognition and Strategies of Visiting Nurses for Supporting Clients' Self-Determination at Home

要旨

　本研究の目的は，在宅療養者の自己決定を支える訪問看護婦の認識と方略を，訪問看護場面の参加観察と，訪問看護婦との面接によって明らかにすることである．対象は訪問看護婦20名と在宅療養者20名であった．

　分析の結果，訪問看護婦の認識の特徴は『選択・決定は在宅療養者自身がする』『気持ちに添う』『在宅療養者に問題を自分のこととして考えてもらいたい』『自分の役割を言葉で伝える』『気持ちに添うことと看護婦の役割意識とのズレの調整』の5カテゴリーが抽出された．さらに方略の特徴は『意志や希望をきく』『動機づけをする』『情報提供する』『一緒に考える』『同意をえる』『認める』『意欲を引き出す』の7カテゴリーが抽出された．訪問看護婦が療養者の自己決定を支えるためには，短い関わりの中で対象の意志を確認する技術と，対象の意志を優先していい状況なのか見極める能力が求められる．

Abstract

　The purpose of this study was to examine the recognition and strategies of visiting nurses who supported clients' self-determination during treatment at home. Data were collected through participant-observation of nursing situations during home visits and interviews with the visiting nurses. The participants were 20 nurses and their 20 clients.

　The following results were obtained. Characteristics of nurses' recognition were: (a) decision-making was done by clients; (b) acting in accordance with their clients' states of wills; (c) wanting clients to consider problems as their own; (d) conveying nurses' roles to clients; and (e) adjusting the deviation between client's wills and clients' perceptions of nurses' roles. As for strategies, seven categories were extracted; (a) hearing clients wills and desires; (b) motivating; (c) offering information; (d) considering together; (e) obtaining consent; (f) praising; and (g) bringing out clients' volition.

　In conclusion, in order to support clients' self-determination during treatment at home, visiting nurses are required to have the skill of adeptly confirming clients' wills, and the ability to discern whether the nursing care planned is supportive of the client's will.